Evidence map›Paper›PMID 42604190›Full record

ArticleJTCVS open2026

Patients with asymptomatic severe mitral regurgitation already have abnormal left ventricular myocardial sarcomeric ultrastructural characteristics.

Yuanjia Zhu, Seung Hyun Lee, Avi Gupta, Catherine A Wu, Jinsuh Jung, Akshay Venkatesh, Sidarth Ethiraj, Charles J Stark, Chris Huynh, Matthew D Vergel and 2 more

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Article in JTCVS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Yuanjia ZhuDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Seung Hyun LeeDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Avi GuptaDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Catherine A WuDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Jinsuh JungDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Akshay VenkateshDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Sidarth EthirajDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Charles J StarkDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Chris HuynhDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Matthew D VergelDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Shin YajimaDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Y Joseph WooDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: Mitral valve (MV) surgery remains a class I recommendation for patients with symptomatic severe primary mitral regurgitation (PMR). For asymptomatic patients with severe PMR and preserved left ventricular (LV) function without atrial fibrillation, pulmonary hypertension, or significant left atrial enlargement, surgical treatment is not currently recommended. However, the nature and extent of LV myocardial ultrastructural alterations in patients who are asymptomatic remain unclear. Methods: Twelve patients with severe PMR were enrolled in this study, 8 of whom were symptomatic and 4 asymptomatic. Three donor hearts were used as controls. LV biopsies were obtained and processed for transmission electron microscopy. Transmission electron microscopy images were acquired from 600× to 25,000× magnification. Quantitative analysis was performed using the ImageJ software. Statistical comparisons were made using a linear mixed-effects model to account for repeated measurements within individuals. Post-hoc pairwise comparisons were conducted using Bonferroni correction. Statistical significance was defined as Results: Qualitatively, myofibrillar disarray, reduced cytoplasmic reserve, and mitochondrial derangement were observed in patients with severe PMR, regardless of presence of symptoms, compared with controls. Quantitatively, the sarcomere length was greater in control patients (1.65 ± 0.23 μm) compared with those who were symptomatic (1.31 ± 0.34 μm, Conclusions: In patients with severe asymptomatic PMR and preserved LV function without atrial fibrillation, pulmonary hypertension, or significant left atrial enlargement, ultrastructural alterations of the LV myocardium are already evident and comparable with those observed in severe symptomatic PMR. These findings suggest that early surgical intervention in patients who are asymptomatic with severe PMR may help prevent further adverse remodeling and potentially improve clinical outcomes.

Indexed as

left ventricularmitral regurgitationsarcomeric

Identifiers

PMID42604190
PMCPMC13477117

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.